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General NPI Number Information
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NPI Number | 1033590427
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Entity Type | Organization
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Legal Business Name | INTERSTATE PHLEBOTOMY SERVICES INC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 3200 DROVER LN
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City | DARIEN
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State | IL
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Zip | 60561-1642
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Country | US
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Telephone | 219-746-6332
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Fax | 219-980-2995
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Provider Business Mailing Address
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Address Line | 3200 DROVER LN
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City | DARIEN
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State | IL
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Zip | 60561-1642
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Country | US
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Telephone | 219-746-6332
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Fax | 219-980-2995
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Authorized Official
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Title or Position | PRESIDENT
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Name | SULTAN AHMAD MIRZA
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Credential |
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Telephone | 219-746-6332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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